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Can primary care physicians jump start the complex PTSD healing journey of the underserved?

As efforts to shine light on the underlying causes of health risk continue, especially as the disparities have become even clearer during this pandemic, the focus remains on the connection between adverse childhood experiences (ACEs) and the burden created on the human body individually and the healthcare system as a whole.  I am so grateful for Dr. Nadine Burke Harris, California’s Surgeon General who established early childhood, health equity and ACEs and toxic stress as key priorities, with a goal to reduce ACEs and toxic stress by half in one generation.

It still amazes me that so many people are not aware of the ACEs data that show the trauma our children endure, especially within low-income communities of color.  It has been out for years and continues to be collected every year, with expanding definitions of what constitutes adverse childhood experiences.  And it becomes frustrating when our healthcare systems continue to simply look at the symptoms of trauma, such as addiction, depression, and anxiety, without addressing the root cause.

I’m encouraged, and I hope you too find it encouraging, to learn that Dr. Burke Harris is starting with a campaign to provide Medi-Cal providers training, clinical protocols, and payment for screening children and adults for ACEs.  For more information on this campaign, you can click here.

It is also encouraging to hear about the research looking at other approaches to the chronic effects of trauma that are showing positive outcomes, especially within underserved primary care patient populations.  One particular pilot study tested the feasibility of a two-session motivational treatment intervention, implemented with Black primary care patients.  The intervention addressed adverse childhood experiences, post-traumatic stress symptoms, health risk behaviors and behavioral health referral acceptance.  The results were encouraging, suggesting that it is feasible to implement a brief motivational treatment with underserved primary care patients, that was received well and connected almost one-third of the participants to behavioral health services to continue the healing journey.

To read more on this pilot study, click the link below:

Can direct neurofeedback help when our minds separate from our bodies?

When we think about human senses, most of us are able to easily identify the five primary senses of sight, hearing, smell, taste and touch.  But did you know that we actually have three more senses that are integral to our fully embodied, lived experience as humans?  These are vestibular senses of body rotation, gravitation and movement, proprioception as the experience of agility, balance and coordination, and interoception as the ability to feel what is going on inside of our bodies.  It is this last one that is more recently coming forward into the light as it is critical in the healing process related to complex trauma.

When our sense of interoception is damaged, we might be challenged to know when we feel hungry or full, cold or hot, and/or thirsty.  It can also make self-regulation difficult.  When we learn it is not safe to attune to this sense or feel betrayed by it, the mind works to separate from the body, learning to ignore any sensations that emanate from the body, for fear those powerful sensations will reveal our inability to attend to them.  This manifested itself in my own experience when I grew up hungry due to food insecurity.  I quickly learned that the personal, physical sensation of discomfort that accompanies hunger was something I could ignore, especially when my next meal was consistently in question.  Then, when food was present, I had difficulty in portion control, often eating so much that I was in physical pain.

The sense of interoception is often adversely impacted when the human body experiences trauma, especially interpersonal trauma in childhood, and can be so badly damaged that it leads to fragmentation, such as dissociative conditions.  And our Western medical model supports this separation of body and mind, where medical students are trained to simply view the body as the focus for treatment and psychotherapists are trained to view the mind – and its thoughts – as the main focus of treatment.  As we start to embrace the inseparable mind-body connection and better understand the impact of complex mental traumatization, we are learning that talking about past traumas in therapy is only part of the healing process.  More is needed!

In fact, before venturing into cognitive trauma work, it is vital to create safety and some level of internal state regulatory capacity, so people recovering from complex post-traumatic stress disorder (C-PTSD) can avoid the overwhelm that leads to dissociation and holds them back from post-traumatic growth.  Research is now showing that neurofeedback therapy (NFT), like direct neurofeedback, can be added to the treatment of C-PTSD as a method of implicit regulation, changing the brain in a way that eases the symptoms of trauma and opening the window wide to deep healing and inner peace.

If you would like to read more, click on the link below: